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The Clinical Picture

Advanced-stage calciphylaxis: Think before you punch

Arsha Sreedhar, MD, Hina A. Sheikh, MD, Charles J. Scagliotti, MD, FACS and Ranjit Nair, MD
Cleveland Clinic Journal of Medicine August 2016, 83 (8) 562-564; DOI: https://doi.org/10.3949/ccjm.83a.15103
Arsha Sreedhar
Department of Internal Medicine, Lehigh Valley Health Network, Allentown, PA
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  • For correspondence: arshasreedhar@gmail.com
Hina A. Sheikh
Department of Pathology, Health Network Laboratories, Allentown, PA
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Charles J. Scagliotti
Department of Surgery, Lehigh Valley Health Network, Allentown, PA
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Ranjit Nair
Department of Internal Medicine, Lehigh Valley Health Network, Allentown, PA
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    FIGURE 1

    The patient presented with extensive necrotic, leathery, violaceous lesions on both calves that resembled eschar. Also noted were adjacent discrete focal violaceous lesions in evolution.

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    FIGURE 2

    (A) Histologic study of the full-thickness biopsy specimen under low magnification showed ulceration and necrosis of the skin and subcutis (hematoxylin and eosin, × 4). (B) Medium magnification showed concentric calcification of a small blood vessel in the subcutis (black arrow) and adjacent ischemic necrosis of the subcutis (white arrow) (hematoxylin and eosin, × 10). (C) High magnification showed concentric deposits of calcium in a small blood vessel in the subcutis, with luminal thrombus (white arrow). Involvement of blood vessels of this caliber is most specific for calciphylaxis (hematoxylin and eosin, × 20).

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Cleveland Clinic Journal of Medicine: 83 (8)
Cleveland Clinic Journal of Medicine
Vol. 83, Issue 8
1 Aug 2016
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Advanced-stage calciphylaxis: Think before you punch
Arsha Sreedhar, Hina A. Sheikh, Charles J. Scagliotti, Ranjit Nair
Cleveland Clinic Journal of Medicine Aug 2016, 83 (8) 562-564; DOI: 10.3949/ccjm.83a.15103

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Advanced-stage calciphylaxis: Think before you punch
Arsha Sreedhar, Hina A. Sheikh, Charles J. Scagliotti, Ranjit Nair
Cleveland Clinic Journal of Medicine Aug 2016, 83 (8) 562-564; DOI: 10.3949/ccjm.83a.15103
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  • Article
    • CALCIPHYLAXIS RISK FACTORS
    • DIAGNOSTIC CLUES
    • DEBRIDEMENT IS CONTROVERSIAL
    • A TEAM APPROACH IMPROVES OUTCOMES
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